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WILMINGTON, Del. (AP) — More than a month after the launch of Delaware’s health insurance exchange, officials report only four Delawareans enrolled for insurance coverage under the Affordable Care Act.

...Yet in the years to come, some workers with employer-provided benefits will see their benefits scaled back because of an Obamacare tax. That portion of the law — known as the “Cadillac tax” — isn’t set to take effect until 2018, but it’s already influencing the benefits packages that employers offer.

“Every employer plan since the passage of the health care law has been working to make sure their health care cost trends keep their plans under the ‘Cadillac tax,’” Steve Wojcik of the National Business Group on Health, a nonprofit that represents large employers, told CBSNews.com.

The administration’s argument for the individual market applies to the employer-based market: No one with health insurance should expect to keep their current plan forever.

“The expectation was never there that a plan is going to be set in stone for any length of time,” Wojcik said. “Plans should adopt to new evidence and new benefits practices — they shouldn’t be set in stone… We’ve wanted to do something about health care costs growing out of control.”

That said, Wojcik added, the “Cadillac tax” is “bringing more immediacy” to the issue, prompting employers to scale back plans they wouldn’t otherwise, “with the 2018 deadline looming.”

“The clear expectation was and is that the ‘Cadillac tax’ — the tax on high-cost health plans — will cause those [employers offering] highly generous plans to pare back benefits somewhat so that they won’t be subject to the tax,” Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities, explained to CBSNews.com. “It’s not going to affect a large number of people to begin with, but it is significant in the longer run in terms of its potential to hold down health care costs.”

In 2018, the rule will impose a 40 percent excise tax on employee benefits exceeding $10,200 for individuals and $27,500 for families. In 2013, the average employer-sponsored for individuals cost $5,884 and the average family plan cost $16,351.

The impact of the tax is concerning to labor groups that have fought with employers for good benefits.

“Yes, if you like your plan, you can keep it, unless you have great benefits,” Lindsay McLaughlin, legislative director for the International Longshore and Warehouse Union, told CBSNews.com....

Obamacare generates profits for the federal government by blocking Americans’ ability to get high-quality advice or services from outside their local area, according to health care experts.

The Obamacare-compliant health benefit plans usually only pay for services within each citizen’s local region, said Dr. Scott Gottlieb, a former government health care official and an expert at the American Enterprise Institute.

Throughout 2014, the small regions will help regulators and executives narrow the variety, quality, number and cost of medical services available to at least three million Americans who already had plans on the individual market and are now being forced into Obamacare.

“They’re very narrow plans, they’re a throwback to the 1980s-style HMOs,” Gottlieb said.

“The majority of plans do not offer care beyond their regions,” said Yevgeniy Feyman, an expert at the New York-based Manhattan Institute.

“What this effectively does is limit the quality of care that some people are able to get,” Feynman said. “The more rural you get, the worse it is going to be,” he added.

In addition, within each region, the regulators and insurance companies seem to be steering enrollees to cheaper local hospitals, he said. In Philadelphia, Pa., for example, the Obamacare plans direct patients to Temple University Hospital, rather than to the higher-rated Hospital of the University of Pennsylvania, he said.

So if sick Americans want to get a second opinion from a specialist doctor in a neighboring county, or want to use get high-quality treatment at far-off specialized cancer or heart center across the state line, they’ll have to pay with extra cash after they’ve paid their mandatory Obamacare premiums, deductibles and co-pays, Gottlieb told The Daily Caller.

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.

The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing....

True reform, he argues, must include redefining doctors' ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the "overuse" of medical care: "Medical school education and post graduate education emphasize thoroughness," he writes. "This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of cost or effect on others."

In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: "Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007).

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care." One sign of progress he sees: "the progression in end-of-life care mentality from 'do everything' to more palliative care...

This was published in 2009 but never made its way onto the general public's TV screen. This article could have really supported Sarah Palin's "death panels" comment, since Emmanuel believes very strongly in rationing care to the elderly:

"Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: "Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia." (Hastings Center Report, November-December, 1996) "

..."It's the law" and "it's here to stay" are statements presented as legitimate arguments, but in reality, they are nothing more than assumptions founded in ignorance, predicated on magnificent and malignant fallacy.

If laws passed by one Congress, or signed by one president, or upheld by one Court were actually meant to be eternal fixtures binding future congresses, presidents, and courts, one might wonder why our Founders didn't chisel the laws they created on a stone beneath a giant statue of Washington, or why the Founders wouldn't prohibit any future provision to amend those laws via constitutional protocol.

We should be eternally grateful that they didn't, shouldn't we? For example, many laws allowing or broadening the institution of slavery were passed by Congress in the 19th century; presidents signed them into law, and the Court of 1857 deemed slavery a constitutional right in the Dred Scott ruling. Should those laws and that ruling have bound American officials in future legislation barring slavery? Prohibition was so clearly understood to be a mistake that required repealing that future lawmakers took it upon themselves to do so, feeling unbound to somehow "make it work" because "it's the law." Should they have done so, or should they have felt bound by previous lawmakers?

Ironically, this is not a concept lost on modern leftists. The Defense of Marriage Act was indeed "the law," passed by Congress and signed by Democrat demigod Bill Clinton, yet they didn't at all see it as an enduring and timeless covenant with the American people in 2013, and they celebrated the judicial activism which heralded its end.

Ah, but the Voting Rights Act was indeed "the law," immovable and unamendable, and so they became enraged at the judicial activism which lifted certain penalizing provisions upon individual states deemed to have a history of "prejudice."

Leftists' selectivity about which laws can and can't be changed is among the most marvelous of hypocrisies. My guess is that had Justice Roberts not concocted the unique appraisal that a penalty for not purchasing insurance is somehow a "tax," and had the individual mandate been deemed unconstitutional, leftists would be similarly enraged...

...But here's the catch: it has to be repealed soon. A decade will be far too long, because as I've argued before, and as history clearly shows, once entitlement services or payments become expectations, it will not matter how broken the system is in the future, or who has to pay, or how much has to be paid to keep the system in place. The system will indeed become a fixture, however malignant, just as federal welfare infrastructure is today. More people than ever before will be receiving these and other entitlements, and they will be entirely dependent upon the government to secure their benefits by any means necessary, including the forceful extraction from the government's taxpaying benefactors -- which could ultimately prove to be a recipe for civil chaos, if not eventual civil war.

√ Stage One – The “tax-payers” can’t identify their cost until it’s too late (Oct/Nov 2013).

√ Stage Two – The “tax-payers” lose their current coverage and cannot replace with anything except Obamacare coverage (2013/2014).

√ Stage Three – The “tax-payers” find out they’re going to pay more, much more, for less freedom, less choices, more mandates they’ll never use because of the regulations no-one was paying attention to.

Stage Four – The “tax-payers” find out their doctor and/or provider is gone, opted out. Provider options become limited to non-existent.

Stage Five – The “tax-payers” realize their previous healthcare premium was considered a pre-tax deduction. (Progressives call these “tax expenditures”).The employer paid premium, and the subsidy provided to assist in Obamacare premium coverage, are both now considered a part of taxable earnings, “wage income”.

Stage Six – The same year employees realize their W2 now shows their employer healthcare benefit as part of their taxable income. Employers will drop their employee coverage. (October 2014 notices for January 1st 2015 cancellations) ALSO (The 2015 W2 and I-1099 forms will show the movement of premium to income).

Stage Seven – The “tax-payers” are joined by the previous “non tax-payers” as the bills come due and tax returns are filed. (April 2015 and April 2016) Tax refunds are reduced substantially as revenues are needed. Folks realize their subsidy is now part of their earnings – that have a bigger tax liability.

Stage Eight – Election year 2016 ! Introduction of “Clintoncare” Hillary Clinton steps in with previous plan from 1990′s, and the nation votes on essentially a single payer plan with promises of lower taxation, et al. By that time so many people will be enrolled in the ACA “Obamacare” the selling point will be around transition to “Clintoncare” being actually easier.